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Giorelli M, Altomare S, Aniello MS, Leone R, Liuzzi D, Plasmati I, Sardaro M, Superbo M, Mennea G, Fioretto N, Guglielmi G, Balzano R, Scarabino T, Cuccorese G, Cialdella F, Campobasso G, Barbara M. Lemierre's syndrome complicated by cerebral venous sinus thrombosis: A life threatening and rare disease successfully treated with empiric antimicrobial therapy and conservative approach. Intractable Rare Dis Res 2022; 11:37-39. [PMID: 35261851 PMCID: PMC8898395 DOI: 10.5582/irdr.2021.01142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/05/2022] Open
Abstract
Lemierre's syndrome (LS) is a "forgotten" condition characterized by septic thrombophlebitis of the jugular vein that follows an otolaryngological infection. Fusobacterium necrophorum is the aetiological agent responsible for the syndrome in adolescents and young adults whereas in older people even common bacteria are involved. Complications arise from spreading of septic emboli distally, i.e. to the brain, lungs, bones and internal organs everywhere in the body. We report a middle-aged woman who presented with headache and bilateral sixth cranial nerve palsy following a sphenoidal sinusitis and left mastoiditis. Imaging revealed thrombotic involvement of the left internal jugular vein as well as of several cerebral venous sinuses thrombosis (CVT). Currently, precise management protocols of LS with CVT complication do not exist although a combination of macrolides and second or third-generation cephalosporins, as well as anti-coagulants represent the mainstream of therapeutics. Surgical drainage is associated to remove septic foci but is burdened by severe complications and side effects. Complete recovery was achieved following pharmacological treatment in our patient. This report adds further evidence that LS complicated by CVT may be effectively treated adopting a conservative approach thus avoiding surgical drainage and severe complications.
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Affiliation(s)
- Maurizio Giorelli
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
- Address correspondence to:Maurizio Giorelli, Operative Unit of Neurology, "Dimiccoli" General Hospital, Viale Ippocrate 11, Barletta 76121, Italy. E-mail:
| | - Sergio Altomare
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Ruggiero Leone
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Daniele Liuzzi
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | | | - Michele Sardaro
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Maria Superbo
- Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Mennea
- Operative Unit of Internal Medicine, "Bonomo" General Hospital, Andria, Italy
| | - Nicola Fioretto
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Guglielmi
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Rosario Balzano
- Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Tommaso Scarabino
- Operative Unit of Radiology, "Bonomo" General Hospital, Andria, Italy
| | - Giuseppe Cuccorese
- Operative Unit of Internal Medicine, "Dimiccoli" General Hospital, Barletta, Italy
| | - Francesca Cialdella
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Giuseppe Campobasso
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
| | - Michele Barbara
- Operative Unit of Otorhinolaryngology, "Dimiccoli" General Hospital, Barletta, Italy
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Baltasar-Corral J, Martín-Rojas RM, Parra-Virto A, Galeano-Valle F, Del-Valle-Diéguez M, Del-Toro-Cervera J, Demelo-Rodríguez P. Torcular herophili and lateral sinus thrombosis: An atypical presentation of Lemièrre's syndrome. Intractable Rare Dis Res 2019; 8:206-209. [PMID: 31523600 PMCID: PMC6743426 DOI: 10.5582/irdr.2019.01071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lemièrre's syndrome (LS) is an uncommon disease characterized by septic thrombophlebitis of the jugular vein in the context of otorhinolaryngologic infections. These patients are often young and the pharyngotonsillar infection is the most frequent primary focus, but other foci like acute otitis media or otomastoiditis have been described. Although the internal jugular vein is the most commonly affected site, a few case reports have been published with thrombosis of other veins, such as the facial vein or transverse sinus. We report the case of a 93-year-old woman with an atypical presentation of LS presenting with thrombophlebitis of the internal jugular vein, transverse sinuses and Herophili torcula after an acute otitis media complicated with acute otomastoiditis. Infectious cerebral venous thrombosis (CVT) is rare and accounts for 6-12% of the total in large adult series and is usually associated to otorhinolaryngologic infections. CVT is an atypical presentation of LS that can be potentially lethal, especially during the acute phase. For this reason, clinical suspicion and early treatment are vital to improve the prognosis of these patients. Although surgical treatment is recommended in cases of LS complicated with CVT, conservative management with antibiotics and anticoagulation lead to ad integrum restitutio without neurological sequelae in our case, suggesting that surgical treatment may not be necessary in all cases of LS complicated with CVT.
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Affiliation(s)
- Jesús Baltasar-Corral
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
| | | | - Alejandro Parra-Virto
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Address correspondence to:Dr. Alejandro Parra-Virto. Internal Medicine Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo, 46, Madrid 28007, Spain. E-mail:
| | - Francisco Galeano-Valle
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | - Jorge Del-Toro-Cervera
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous thromboembolism Unit, Department of Internal Medicine, University General Hospital Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
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